Like any new large IT system, EMR applications have bugs that need working out. And system downtime has much graver implications in healthcare than it does in other industries.
“If a doctor is right in the middle of digging into somebody’s chest and the computer goes down, it’s quite different than if productivity suffers when the system goes down in a bank or manufacturing company,” Nelson explains. “A number of very large [EMR] implementations have been put on hold or stopped right in the middle of the project because they had just not adequately projected the type of hardware and software necessary to ensure the levels of performance that the environment requires.”
The technology itself has grown more robust, says Nelson, but the success of an EMR project, he and other consultants emphasize, depends on much more than the technology.
“In the past, organizations too often have deployed EMR systems from strictly an IT-system perspective, rather than recognizing a clinical perspective,” says Fickenscher. “If you don’t change the work flow, you’re basically adding work on top of work.”
He also says that EMR implementations have suffered from lack of adequate decision support and a lack of direction. If healthcare providers are not notified when a problem occurs, or if they are overnotified when an issue arises, they are unlikely to rely on or use the EMR system.
“Too many organizations are not clear about their implementation metrics,” Fickenscher adds. “At the end of the day, how do we know if we were successful or not, and what are the metrics we are using to define that?”
End users will not use an IT system if it does not make their work more efficient and more effective. Even if the system succeeds on those counts, convincing nurses, doctors, and specialists to change their ways poses a major challenge.
“We’re talking about a highly professional and educated group,” says Redd. “It is a challenging group from a change-management perspective. This is not like changing processes and introducing new technology within a call center. Doctors are habitual creatures by nature. That’s how they learn their vocation.”
Doctors are also, for the most part, free agents — entrepreneurial professionals who work for themselves and not the hospitals in which they frequently practice. “To them, time and money is the same thing,” Nelson explains. “The more patients they can see and the faster their throughput is, the more it helps them financially.” Doctors often support EMR-related change, “unless it slows them down,” Nelson adds. “Physician adoption is a major issue.”
EMR: The Inside Story
